title: A retrospective study: the prognostic value of anemia, smoking and drinking in esophageal squamous cell carcinoma with primary radiotherapy.
abstract: BACKGROUND
  Few studies have investigated the relationship between anemia, smoking, drinking and survival in esophageal squamous cell carcinoma (ESCC) with primary radiotherapy. This study had the aim of evaluating the prognostic value of anemia, smoking and drinking in patients receiving primary radiotherapy for ESCC.
  
  
  METHODS
  A total of 79 patients who underwent radiotherapy during initial treatment for ESCC were included in this study. The 2-year overall survival (OS) and disease-free survival (DFS) were analyzed between the anemic and non-anemic groups, non-smokers and smokers, and non-drinkers and drinkers using the Kaplan-Meier method and the Cox proportional hazards model.
  
  
  RESULTS
  There were 79 patients (10 male) of median age 63 (range 38 to 84) years. The 2-year OS and DFS were 36% and 25%, respectively, in the non-anemic group, and 17% and 13%, respectively, in the anemic group (P = 0.019 for OS; P = 0.029 for DFS) using the Kaplan-Meier method. Survival analysis using the Kaplan-Meier method showed that the 2-year OS and DFS had no statistical difference between smoking, drinking and survival. In a univariate analysis, anemia was identified as a significant prognostic factor for 2-year OS (hazard ratio (HR) = 1.897; P = 0.024) and 2-year DFS (HR = 1.776; P = 0.036), independent of tumor, lymph node, metastasis (TNM) stage. In a multivariate analysis, anemia was identified as a highly significant prognostic factor for 2-year OS (HR = 2.125; P = 0.011) and 2-year DFS (HR = 1.898; P = 0.025), independent of TNM stage and initial treatment. We found no statistical difference in the 2-year OS and DFS associated with smoking (P > 0.2) and drinking (P > 0.6) using univariate and multivariate analysis.
  
  
  CONCLUSIONS
  Smoking and drinking were not prognostic for 2-year OS or DFS. Anemia before radiotherapy was associated with poor prognosis and an increased risk of relapse, which may serve as a new prognostic characteristic in ESCC treated with primary radiotherapy. Hemoglobin is a routine examination and anemia is therefore simple and quick to determine.
authors.affiliation: Department of Radiotherapy, Cancer Centre, Qilu Hospital, Shandong University, 107 Wenhuaxi Rd, Jinan, Shandong 250012, China. qilucyf@126.com.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Hui
authors.initials: H
authors.lastname: Han
authors.forename: Chuansheng
authors.initials: C
authors.lastname: Wang
authors.forename: Jianbo
authors.initials: J
authors.lastname: Wang
authors.forename: Guangyu
authors.initials: G
authors.lastname: Zhang
authors.forename: Fangli
authors.initials: F
authors.lastname: Cao
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D000740:Anemia / Q000150:complications*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality / Q000532:radiotherapy; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012907:Smoking; D015996:Survival Rate